The hidden economic burden of air pollution-related morbidity : evidence from the Aphekom project

Public decision-makers commonly use health impact assessments (HIA) to quantify the impacts of various regulation policies. However, standard HIAs do not consider that chronic diseases (CDs) can be both caused and exacerbated by a common factor, and generally focus on exacerbations. As an illustration, exposure to near road traffic-related pollution (NRTP) may affect the onset of CDs, and general ambient or urban background air pollution (BP) may exacerbate these CDs. We propose a comprehensive HIA that explicitly accounts for both the acute effects and the long-term effects, making it possible to compute the overall burden of disease attributable to air pollution. A case study applies the two HIA methods to two CDs-asthma in children and coronary heart disease (CHD) in adults over 65-for ten European cities, totaling 1.89 million 0-17-year-old children and 1.85 million adults aged 65 and over. We compare the current health effects with those that might, hypothetically, be obtained if exposure to NRTP was equally low for those living close to busy roads as it is for those living farther away, and if annual mean concentrations of both PM10 and NO2-taken as markers of general urban air pollution-were no higher than 20 μg/m(3). Returning an assessment of € 0.55 million (95 % CI 0-0.95), the HIA based on acute effects alone accounts for only about 6.2 % of the annual hospitalization burden computed with the comprehensive method [€ 8.81 million (95 % CI 3-14.4)], and for about 0.15 % of the overall economic burden of air pollution-related CDs [€ 370 million (95 % CI 106-592)]. Morbidity effects thus impact the health system more directly and strongly than previously believed. These findings may clarify the full extent of benefits from any public health or environmental policy involving CDs due to and exacerbated by a common factor.